Marginalization through aggregation

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Publication Date: 
Thu, 2010-09-30

Cardiovascular disease is the second highest cause of mortality in Canada, eclipsed only by cancer as the highest cause of death for Canadians. When the aggregate CVD numbers are compared for women and for men, the sexes appear to have similar experiences of CVD – in 2000, 50.5% of all cardiovascular deaths in Canada were women and 49.5% were men. However, aggregation masks dramatic differences for men and for women in terms of cardiovascular disease.

Applying a sex- and gender-based analysis reveals that historically, men have had higher mortality rates from CVD, leading to the perception that CVD is a disease mainly afflicting middle-aged men. Therefore, until recently research has often only included men, leading to a male bias in our knowledge about CVD treatment and symptoms. But research has since demonstrated that the symptoms of CVD for men and women can be different, and many groups, including The Heart and Stroke Foundation of Canada, are launching education campaigns on the topic. These emerging sex-specific findings have been possible because CVD-related research has begun to include both men and women and disaggregate data by sex, with some researchers even beginning to develop sex-sensitive indicators of CVD. In other words, aggregation has been challenged, and sources of marginalization that once were invisible are now plain to see. This new line of research will improve cardiovascular care across the Canadian population.

Cardiovascular disease is only one example of how critical issues for women’s health can be lost through data aggregation, a lack of sex- and gender-based analysis, (SGBA) or not collecting data broken down by sex in the first place. There is a fundamental question underlying this issue – how can our surveillance systems collect, process, and report on the data that are important to women’s health?

Some argue that a female-specific set of health indicators (a single set of measurements that captures the status of women’s health) is needed. Others argue for making mainstream health indicators more gender-sensitive (improving how our current systems monitor issues that vary for men and women) by improving current indicators and complementing them with measures that better capture women’s and men’s health. Progress in both of these streams has been captured within Canadian Women’s Health Indicators: An Introduction, Environmental Scan, and Framework Evaluation, a report recently released by the British Columbia Centre of Excellence for Women’s Health. The report traces the evolution of women’s health indicators over the past 20 years, highlighting the recent and ongoing work of several key Canadian women’s health organizations. The full report can be viewed or downloaded  here.

Gaps in Canada’s ability to report on women’s health began to receive attention in the mid 1990s. In 1998, the Laboratory Centre for Disease Control at Health Canada noted a lack of data concerning women as a gap in their surveillance. In response, Health Canada assembled an Advisory Committee on Women’s Health Surveillance to oversee the development of women’s health surveillance in Canada. The committee was informed by the efforts of women’s health researchers working at the national, provincial, and local levels and their recommendations have helped shape future efforts. These include development of frameworks for women’s health indicators, attempts to develop sex-specific and gender-sensitive sets of indicators, and a range of other initiatives driven by Canadian women’s health researchers and other interested parties.

The POWER Study (Project for an Ontario Women’s Health Evidence-Based Report) is one such organization pushing for change. Throughout this multi-year project, the POWER team has been producing the POWER Report which examines current health information to uncover the differences between men and women and between various groups of women. Its goals are to examine gender differences on a comprehensive set of evidence-based indicators as well as differences among women associated with socioeconomic status, ethnicity, and geography. The POWER report provides an in-depth look at numerous health domains representing the leading causes of morbidity and mortality among women including: burden of illness, cancer, depression, cardiovascular disease and access to health care. Individual reports on these specific health domains provide an in-depth analysis of women’s health data, and include a strong diversity component, highlighting the health of specific subpopulations in Ontario. The POWER Study is using performance measurement and reporting on gender and socioeconomic inequities in health and health care as a tool for knowledge translation.

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